Healthcare Provider Details

I. General information

NPI: 1023652914
Provider Name (Legal Business Name): GRACE GERIATRIC CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2019
Last Update Date: 11/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8883 WESTMINSTER AVE
GARDEN GROVE CA
92844-2608
US

IV. Provider business mailing address

8883 WESTMINSTER AVE
GARDEN GROVE CA
92844-2608
US

V. Phone/Fax

Practice location:
  • Phone: 657-208-2221
  • Fax: 657-400-9174
Mailing address:
  • Phone: 657-208-2221
  • Fax: 657-400-9174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. PETER TRUNG-THUY LE
Title or Position: CO-OWNER
Credential: PAC
Phone: 949-877-9194